Information Collection

Employer Services Agreement and Profile

IC 233423 under ICR 202208-0970-002 · OMB 0970-0370.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0370 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Employer Services Agreement and Profile Form and Instruction
1 Employer Services Agreement and Profile 1 - 0970-0370_Employer Services Profile_020422.pdf Form and Instruction
1 Employer Services Agreement and Profile 1 - 0970-0370_Employer Services Profile_020422.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Employer Services Agreement and Profile	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Employer Services Agreement and Profile	1 - 0970-0370_Employer Services Profile_020422.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,508	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	9,508	9,508
Annual IC Time Burden (Hours)	761	761
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.